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Home My WebLink AboutCOI - City of Bremerton WWTPSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 6/9/2022 Scirocco Group –Randolph777TerraceAve.,suite 309Suite309HasbrouckHeightsNJ07604 June Dulio ext.302 201-727-0070 201-727-0080 jdulio@sciroccogroup.com Lloyd's 524210 REINPUM-01 Hartford Insurance Company 914ReinerPumpSystems,Inc.53 US Highway 206StanhopeNJ07874 1706133445 A X 1,000,000 X 50,000 X 10,000 DEDUCT 5,000 1,000,000 2,000,000 X Y Y ENVPKGS4232652 6/5/2022 6/5/2023 2,000,000 A 1,000,000 X X ENVPKGS4232652 6/5/2022 6/5/2023 A X 1,000,000 X ENVXSS232651 6/5/2022 6/5/2023 1,000,000 B X N 13WBCBX5939 2/5/2022 2/5/2023 1,000,000 1,000,000 1,000,000 City of Bremerton WWTP is added as Additional Insured ATIMA on a primary and non-contributory basis,as respects to the Sale of Water/Waste WaterPumps,when required by written contract and to the extent provided by the actual policy language of the General Liability Policy.Waiver of Subrogation shallapplywhenrequiredbywrittencontract. City of Bremerton WWTP1600OysterBaySouthBremertonWA98312 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to B.With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" ordamage" or "personal and advertising injury""property damage" occurring after:caused, in whole or in part, by:1.All work, including materials, parts or1.Your acts or omissions; or equipment furnished in connection with such work, on the project (other than service,2.The acts or omissions of those acting on your maintenance or repairs) to be performed by orbehalf; on behalf of the additional insured(s) at thein the performance of your ongoing operations for location of the covered operations has beenthe additional insured(s) at the location(s) completed; ordesignated above. 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ENVPKGS4232652 BLANKET Additional Insured when required by written contract. All projects / locations POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ENVPKGS4232652 BLANKET Additional Insured when required by written contract.ALL projects / locations ϲϬϴϭhϬϬϱϮϳϱ, ,ĂŵŝůƚŽŶDĂŶĂŐŝŶŐ'ĞŶĞƌĂůŐĞŶĐǇŵĞƌŝĐĂƐ>> ϰϬϬDĂĚŝƐŽŶǀĞŶƵĞ͕^ƵŝƚĞϭϲ EĞǁzŽƌŬ͕EzϭϬϬϭϳh^ >ůŽǇĚƐ^ǇŶĚŝĐĂƚĞϰϬϬϬDĂŶĂŐĞĚďǇ ,ĂŵŝůƚŽŶDĂŶĂŐŝŶŐŐĞŶĐǇ>ŝŵŝƚĞĚ /ŶƐƵƌĞĚEĂŵĞ͗ZĞŝŶĞƌWƵŵƉ^ǇƐƚĞŵƐ͕/ŶĐ͘ ĨĨĞĐƚŝǀĞĂƚĞKĨŶĚŽƌƐĞŵĞŶƚ͗WŽůŝĐǇEƵŵďĞƌ͗EsW<'^ϰϮϯϮϲϱϮ d,/^EKZ^DEd,E'^d,WK>/z͘W>^Z/dZ&h>>z͘ WZ/DZzEEKEKEdZ/hdKZzʹKd,Z/E^hZEKE/d/KE dŚŝƐĞŶĚŽƌƐĞŵĞŶƚŵŽĚŝĨŝĞƐŝŶƐƵƌĂŶĐĞƉƌŽǀŝĚĞĚƵŶĚĞƌƚŚĞĨŽůůŽǁŝŶŐ͗ KDDZ/>'EZ>>//>/dzKsZ'&KZD KEdZdKZΖ^WK>>hd/KE>//>/dzKsZ'&KZD WůĞĂƐĞƌĞĨĞƌƚŽĞĂĐŚŽǀĞƌĂŐĞ&ŽƌŵƚŽĚĞƚĞƌŵŝŶĞǁŚŝĐŚƚĞƌŵƐĂƌĞĚĞĨŝŶĞĚ͘tŽƌĚƐƐŚŽǁŶŝŶƋƵŽƚĂƚŝŽŶƐŽŶƚŚŝƐĞŶĚŽƌƐĞŵĞŶƚ ŵĂǇŽƌŵĂǇŶŽƚďĞĚĞĨŝŶĞĚŝŶĂůůŽǀĞƌĂŐĞ&ŽƌŵƐ͘ dŚĞĨŽůůŽǁŝŶŐŝƐĂĚĚĞĚƚŽƚŚĞKƚŚĞƌ/ŶƐƵƌĂŶĐĞĐŽŶĚŝƚŝŽŶŽĨƚŚĞŽǀĞƌĂŐĞ&Žƌŵ;ƐͿŝŶĚŝĐĂƚĞĚĂďŽǀĞĂŶĚƐƵƉĞƌƐĞĚĞƐĂŶǇ ƉƌŽǀŝƐŝŽŶƚŽƚŚĞĐŽŶƚƌĂƌǇ͗ WƌŝŵĂƌǇĂŶĚEŽŶĐŽŶƚƌŝďƵƚŽƌǇ/ŶƐƵƌĂŶĐĞ dŚŝƐŝŶƐƵƌĂŶĐĞŝƐƉƌŝŵĂƌǇƚŽĂŶĚǁŝůůŶŽƚƐĞĞŬĐŽŶƚƌŝďƵƚŝŽŶĨƌŽŵĂŶǇŽƚŚĞƌŝŶƐƵƌĂŶĐĞĂǀĂŝůĂďůĞƚŽĂŶĂĚĚŝƚŝŽŶĂůŝŶƐƵƌĞĚƵŶĚĞƌ ǇŽƵƌƉŽůŝĐǇƉƌŽǀŝĚĞĚƚŚĂƚ͗ ;ϭͿdŚĞĂĚĚŝƚŝŽŶĂůŝŶƐƵƌĞĚŝƐĂEĂŵĞĚ/ŶƐƵƌĞĚƵŶĚĞƌƐƵĐŚŽƚŚĞƌŝŶƐƵƌĂŶĐĞ͖ĂŶĚ ;ϮͿ zŽƵ ŚĂǀĞ ĂŐƌĞĞĚ ŝŶ ǁƌŝƚŝŶŐ ŝŶ Ă ĐŽŶƚƌĂĐƚ Žƌ ĂŐƌĞĞŵĞŶƚ ƚŚĂƚƚŚŝƐ ŝŶƐƵƌĂŶĐĞ ǁŽƵůĚ ďĞ ƉƌŝŵĂƌǇ ĂŶĚ ǁŽƵůĚ ŶŽƚ ƐĞĞŬ ĐŽŶƚƌŝďƵƚŝŽŶĨƌŽŵĂŶǇŽƚŚĞƌŝŶƐƵƌĂŶĐĞĂǀĂŝůĂďůĞƚŽƚŚĞĂĚĚŝƚŝŽŶĂůŝŶƐƵƌĞĚ͘ >>Kd,ZdZD^EKE/d/KE^ZD/EhE,E' /ŶĐůƵĚĞƐĐŽƉǇƌŝŐŚƚĞĚŵĂƚĞƌŝĂůŽĨ/ŶƐƵƌĂŶĐĞ^ĞƌǀŝĐĞƐKĨĨŝĐĞ͕/ŶĐ͕͘ǁŝƚŚŝƚƐƉĞƌŵŝƐƐŝŽŶ͘ EsD>ϬϬϭϯ;Ϭϭ͘ϮϭͿ,ĂŵŝůƚŽŶDĂŶĂŐŝŶŐ'ĞŶĞƌĂůŐĞŶĐǇŵĞƌŝĐĂƐ͕>> ϮϮDĂǇϮϬϮϮ ϲϬϴϭhϬϬϱϮϳϱ, ,ĂŵŝůƚŽŶDĂŶĂŐŝŶŐ'ĞŶĞƌĂůŐĞŶĐǇŵĞƌŝĐĂƐ>> ϰϬϬDĂĚŝƐŽŶǀĞŶƵĞ͕^ƵŝƚĞϭϲ EĞǁzŽƌŬ͕EzϭϬϬϭϳh^ >ůŽǇĚƐ^ǇŶĚŝĐĂƚĞϰϬϬϬDĂŶĂŐĞĚďǇ ,ĂŵŝůƚŽŶDĂŶĂŐŝŶŐŐĞŶĐǇ>ŝŵŝƚĞĚ /ŶƐƵƌĞĚEĂŵĞ͗ZĞŝŶĞƌWƵŵƉ^ǇƐƚĞŵƐ͕/ŶĐ͘ WŽůŝĐǇEƵŵďĞƌ͗EsW<'^ϰϮϯϮϲϱϮ :$,9(52)75$16)(52)5,*+762)5(&29(5< $*$,16727+(567286:$,9(52)68%52*$7,21 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 (/(&7521,&'$7$/,$%,/,7<&29(5$*(3$57 /,4825/,$%,/,7<&29(5$*(3$57 32//87,21/,$%,/,7<&29(5$*(3$57'(6,*1$7('6,7(6 32//87,21/,$%,/,7</,0,7('&29(5$*(3$57'(6,*1$7('6,7(6 352'8&76&203/(7('23(5$7,216/,$%,/,7<&29(5$*(3$57 5$,/52$'3527(&7,9(/,$%,/,7<&29(5$*(3$57 81'(5*5281'6725$*(7$1.32/,&<'(6,*1$7('7$1.6 6&+('8/( 1DPH2I3HUVRQV2U2UJDQL]DWLRQV 5HLQHU3XPS6\VWHPV,QF1$ ,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV 7KHIROORZLQJLVDGGHGWR3DUDJUDSK7UDQVIHU2I5LJKWV2I5HFRYHU\$JDLQVW2WKHUV7R8VRI6HFWLRQ,9± &RQGLWLRQV :HZDLYHDQ\ULJKWRIUHFRYHU\DJDLQVWWKHSHUVRQVRURUJDQL]DWLRQVVKRZQLQWKH6FKHGXOHDERYHEHFDXVHRI SD\PHQWVZHPDNHXQGHUWKLV&RYHUDJH3DUW6XFKZDLYHUE\XVDSSOLHVRQO\WRWKHH[WHQWWKDWWKHLQVXUHGKDV ZDLYHGLWVULJKWRIUHFRYHU\DJDLQVWVXFKSHUVRQVRURUJDQL]DWLRQVSULRUWRORVV7KLVHQGRUVHPHQWDSSOLHVRQO\WR WKHSHUVRQVRURUJDQL]DWLRQVVKRZQLQWKH6FKHGXOHDERYH &*